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This is VAERS ID 118639

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 118639
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 456055 / 3 RL / IM
MMR: MMR II / MSD 1183H / 0 LA / SC
OPV: ORIMUNE / LEDERLE 0790B / 3 - / PO
VARCEL: VARIVAX / MSD 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: SIDS, EDEMA, LUNG DIS, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 12/8/2009

VAERS ID: 118639 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-11 1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPH: TETRAMUNE / LEDERLE 456055 / 3 RL / IM
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES 456055 / 3 RL / IM
MMR: MMR II MEASLES + MUMPS + RUBELLA (MMR II) / MSD MERCK & CO. INC. 1183H / 0 LA / SC
OPV: ORIMUNE POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LEDERLE LABORATORIES 0790B / 3 - / PO
VARCEL: VARIVAX VARICELLA (VARIVAX) / MSD MERCK & CO. INC. 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, SIDS, Sudden infant death syndrome, Unevaluable event, EDEMA, LUNG DIS, SLEEP POSITION

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 3/14/2014

VAERS ID: 118639 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 456055 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / LEDERLE LABORATORIES PFIZER/WYETH 0790B / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 6/14/2014

VAERS ID: 118639 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 3/14/2015

VAERS ID: 118639 Before After
VAERS Form:
Age:1.2
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 2/14/2017

VAERS ID: 118639 Before After
VAERS Form:
Age:1.2 1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 0 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 3 - / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 0 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 9/14/2017

VAERS ID: 118639 Before After
VAERS Form:(blank) 1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 3 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 0 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 3 4 - MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 0 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 2/14/2018

VAERS ID: 118639 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 6/14/2018

VAERS ID: 118639 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 8/14/2018

VAERS ID: 118639 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 9/14/2018

VAERS ID: 118639 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;


Changed on 10/14/2018

VAERS ID: 118639 Before After
VAERS Form:1
Age:1.19
Sex:Male
Location:California
Vaccinated:1999-01-14
Onset:0000-00-00
Submitted:1999-02-01
Entered:1999-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 456055 / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1183H / 1 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0790B / 4 MO / PO
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1260H / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lung disorder, Oedema, Sudden infant death syndrome, Unevaluable event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:1999-01-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: EXPMP by Lederle lot# C220 given 14JAN99;
Current Illness: NONE
Preexisting Conditions: URI w/ rash & febrile sz 11/11/98; gastroenteritis 11/19/98; unspecified cornea disorder 6/11/98
Allergies:
Diagnostic Lab Data: autopsy pending;
CDC 'Split Type':

Write-up: pt died in sleep 14 days p/vax;no signs of illness prior to death;possible SIDS, possibly unrelated;

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